Please help me. I have had anxiety and panic disorder since I was a child (about 12 yr). I'm 22 now (and female). Traumatic experiences one after another happened in high school (things like deaths of best friends, drug trade in Washington DC, gang gun fights, etc.), and in my 2nd year of college I was diagnosed with PTSD. There's a summary of my mental health.

Now the real problem. I've been prescribed xanax for 2 1/2 years and was just switched to clonazepam a few months ago, for panic disorder. At college, I became madly addicted to adderall, and this has been ongoing for 3 full years. At first I was only taking 20 - 60 mg, but by year 2 I was pulling all-nighters and taking 60 - 200 mg IR daily. At the same time, I was taking 1-3mg alprazolam daily and now I'm taking 1-3mg klonopin daily. I've also tried every drug in the book, including things like DMT, but not meth or crack.

I am having the hardest time quitting. I have the chills constantly and can't seem to regulate my body temperature (problems with the hypothalamus??) I cannot do inpatient treatment. I just got a job in July and can't afford to lose it. I've already missed enough work. I am seeing a psychologist.

Other relevant info: both of my parents are high-function, law enforcement, alcoholicsI've been smoking weed for 4 years

Have I done permanent damage to my brain? Will I ever be who I used to be? What is going on with my brain chemistry? Please help me understand this, I am miserable.

Dr. Richard Schultz Says...

Thank you very much for writing to me, and I am glad to hear that you wish to recover and begin living a life free of anxiety and addiction.

Let me begin by saying that, of your top 10 concerns, permanent neurological, neurochemical, metabolic or thermostatic issues should probably be 260 through 264 (and I hope that is comforting to you). At the TOP of the list, however, are some significant polysubstance addiction issues, with a family history of alcoholism, overlying longstanding effects of trauma and anxiety symptoms.

You have described abusing stimulants, cannabis, benzodiazepines, and multiple street drugs. Your body and brain are therefore on a CONSTANT roller coaster; these various agents are interacting with one another, and with your physiology and chemistry, in some very complex ways, and it sounds as if you are just barely staying ahead of the curve in terms of rebound effects and symptoms of withdrawal (which could certainly account for the chills and body temperature issues you described).

Anyway, given what you are using, and why you are using it, it would be very, very odd if you DIDN'T feel kind of crazy, miserable and out of control. What I am saying is that there is no mystery here.

I do want you to know that it is not at all uncommon for individuals with a history of trauma, or underlying vulnerabilities to depression or anxiety to begin reaching for substances as a means of attempting to "medicate" or soothe their distress. As with all addictive behaviors, the initial payoff of this self-medication (relief from psychological symptoms) may feel significant, but lessens dramatically over time, as the costs of such behavior continue to rise. When we abuse substances to "numb" our anxiety or other unwanted feelings, those unwanted feelings tend to grow stronger, increasing our fear of them, and reinforcing our self-medicating behavior. Even the use of benzodiazapines such as alprazolam or clonazepam, while sometimes effective in the short-term, can actually lead to the persistence and worsening of anxiety over time.

So, the solution is actually not very complicated. You must first address your addiction issues. Although I cannot be sure, based on what you have said, my guess is that moderation is probably NOT going to be an option for you (meaning that if you use at all, you will quickly slide back down the slippery slope into full-on relapse), at least initially. I trust that your psychologist is in the loop with you on all of this. If not, lay it on the table and ask for help. Your therapist can and should immediately refer you to a a physician that specializes in addiction, and who will help guide you in taper off of the habit-forming substances you are using. Trying to do this yourself could be very unpleasant, scary and even dangerous (and it might send you running back in the opposite direction), so I do urge you to consult a medical professional to assist you with this ASAP. I understand that you may feel ashamed to disclose the behavior in which you have been engaging, but remember that "we are only as sick as the secrets we keep."

Speaking of secrets, I wonder if your parents are aware of your struggle? I hope that their own experiences with addiction have led them to recovery, and if so, that they can indeed be of support to you, and provide you with some guidance. If this is not the case, I am very sorry, but still think you benefit from unburdening yourself by opening up to them, or to other older and trustworthy family members. You may also need to downsize your work and school schedule as you work on getting clean and healthy, and family support will likely be very helpful in assisting you to do this.

As further regards treatment, weekly psychotherapy is NOT deemed to be effective as a standalone approach to most addictions, and it is also not necessary in all cases for individuals to attend a residential rehabilitation or detoxification to get clean. The task of recovery will, however, require GREAT resolve, courage and motivation on your part, and the attendance of 12 step meetings (or equivalent recovery-focused support meetings, such as "Rational Recovery"), several times per week. If you can do 90 meetings in 90 days (not uncommon for the newly sober), your chances of success will be greatly increased. Twelve step programs can provide you with a community of support from indviduals who have struggled as you have and are, individual support from a sponsor, and a structure for psychological and behavioral recovery. They are also free of charge, and meetings will also give you something to do with your time instead of using. As they say, "new playgrounds and new playmates" are required for recovery.

Since you cannot "think through your drink," so to speak, it is probably important for you to make some solid progress on the addiction issues (i.e., get sober and stay sober) before you will be able to meaningfully tackle the unpleasant symptoms of anxiety, depression or post-traumatic phenomena lurking beneath that synthetic haze. The purpose of the haze was to mask and block these underlying symptoms in the first place, or so it sounds, and a worsening of your anxiety has occurred as a result of runnning from it. "That which we resist, persists."

With regard to psychological treatment, I would hope that your current therapist does have expertise working with anxiety and substance abuse, and has a solid grasp of cognitive-behavioral technique (which has shown to be most effective with anxiety disorders, and also has great utility in working with addiction). If this is not the case, find a new therapist. If you need help identifying the right practitioner, you can get a referral from the addiction psychiatrist to whom you are referred, consult the referral list on ChooseHelp.com, or you can visit www.abct.org for a list of providers who specialize in this area.

If you would like to begin educating and helping yourself right away on the psychological side, immediately obtain and read the book "When Panic Attacks" by David Burns. It will provide you with an excellent grounding in the cognitive-behavioral treatment of anxiety. Two other very useful resources will be "Reclaiming Your Life From a Traumatic Experience" by Barbara Rothbaum and "Trauma and Recovery" by Judith Herman. Therapy is very important, but doing work on your own is equally necessary. Most people do not make change until they absolutely have to, and it sounds like this may be a chance for you to move forward before you lose anything else in your life.

So, I hope that you have found at least some of what I have written to be useful in guiding you through this difficult time. I am sorry for the struggles you are facing, but very glad to hear you are wanting change. I wish you great internal peace and compassion for yourself as you pursue this path, and hope that you can navigate the numpy road with belief in yourself. I will end with another quote (I'm rather fond of them, as you can tell), which is:

"Whether you think you can recover, or think you can't, you're probably right."